I'm interested in the observations of anyone who has worked with infants being weaned off of therapeutic pain medications rather than illicit drugs (heroin, "illegally" obtained opiates).
This is a completely hypothetical situation that evolved during a conversation with another nurse, about the advancements in the treating of chronic pain over the last few years. It is something neither of us have encountered or even heard of but we know it has to exist.
The situation we have in mind involves a mother with a serious medical condition who requires the use of sustained release pain meds and was unable to wean off during the pregnancy. To keep it simple we are assuming the mother had good prenatal care and diet, no smoking, alcohol or illegal drugs and pain medication(s) were taken as prescribed.
Are there established protocols for these infants?
If so, do they differ from those for babies born addicted to illicit opiates?
Is the drug used for weaning the same one they were exposed to (ex: fentanyl, MS, oxy/hydrocodone)?
How is the starting dosage determined?
In your opinion do these babies tolerate the process better or worse than babies exposed illicit opiates?
In your opinion do these babies seem to have more or less complications than babies exposed to illicit opiates?
In your opinion does the withdrawl/detox process seem "easier" on the baby with some drugs over others?
Like the previous poster, we treat legal and illegal drug withdrawal with the same protocol (abstinence scoring, non-pharmacological management and pharmacological management). This type of baby should be in the quietest area possible, allowed a pacifier, swaddled, etc. We use morphine or methadone. I prefer methadone. IMO it works much better. The only thing that really matters is that you use an opioid to treat opioid withdrawal. Some nurses seem to think versed or ativan treat withdrawal and they don't. We get the baby off the methadone by spacing out the meds (q4h, then q6h, then q8h, etc) first then decreasing the dose. Cutting the dose first instead of spacing out the meds is nasty IMO unless you are decreasing the doses by very small amounts.
I have some fairly strong opinions on this matter because my first hospital dealt with withdrawal SO often (they actually have an entire L&D/PP ward for chemically dependent women) that they were awesome at it. When I changed hospitals I was horrified by how undertreated withdrawal was. The nurses I worked with often underscored the babies on the abstinence scoring tools so they wouldn't give the PRN med. Of course in report they would talk about the baby being excessively irritabe, sweaty, febrile, not tolerating feeds, having loose watery stools, not sleeping between meals but then tell me the abstinence scores were always less than 3... In that hospital I think it was best if the med was scheduled rather than PRN.
I do think babies born to mothers using legal prescription meds as they were prescribed fare better in general, but that has more to do with prenatal care and lifestyle than the type of med. I've worked with lots of drug babies born to mothers with diseases like sickle cell who used narcotics.
Last edit by fergus51 on May 25, '06